Individual
TRACY JEWELL ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
905 MAIN ST, WEST LIBERTY, KY 41472-1023
(606) 743-4808
(606) 743-4716
Mailing address
PO BOX 690, BEATTYVILLE, KY 41311-0690
(606) 464-0151
(606) 464-0152
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
252244
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
252244
LCSW LICENSURE
KY
05
—
7100499630
—
KY
Enumeration date
11/30/2007
Last updated
11/02/2020
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